Care of the child with asthma is often inadequate and inefficient in human and economic terms because 1) confused and inconsistent approaches to management at home and 2) the use of multiple emergency rooms usually with inaccessible medical records. We hypothesize that the management of asthma will be improved by providing the families of asthmatic children with a home-based ongoing medical record summary, the Home Health Record. To test this hypothesis, we first developed a Record which provides an up-to-date medical summary including the plan of treatment, a log of emergency visits for asthma and an educational section to help families manage asthma at home. Use of the Record provides the physician and family with a common base of information for planning therapy. Possession of the Record by the family insures the availability of medical information regardless of where the child is taken for care. Based on a promising pilot study, we now propose a controlled study to test whether the Home Health Record results in improved management of childhood asthma. A sample of 200 subjects will be randomly drawn from the Pediatric Emergency Service of a large municipal hospital; 100 subjects will be selected to use the Record for one year and 100 will serve as controls. Parents will be interviewed at study entry to document emergency room (ER) use, the present home care, and to estimate the cost of care. Objective measures of the impact of Record use include frequency of ER visits, number of hospitalizations, school attendance, the number and frequency of changes in the drug regimen fand family's actual ability to manage asthma. Questionnaires with scaled responses from the parents and clinic physicians will be completed at study entry and after one year and will be used to measure objectively the impact of the Record on achieving a common base of information for management. Records also will be reviewed to determine how the drug regimen changed during the experimental period and to establish the cost of care. In total, the study provides an objective evaluation of the impact of the Home Health Record on improving the care of children with asthma by physicians and families. The results should be applicable to children and adults with a wide variety of chronic disorders that require frequent medical care.